Objective To describe the technique and characteristics of simple hand-assisted laparoscopic resection of renal and adrenal. Methods A total of 37 patients (22 males and 15 females) underwent simple hand-assisted laparoscopic resection of renal and adrenal from June 1999 to April 2004.Their mean age was 52 years (range,25～65 years).Renal resection group included 29 cases,including 13 of renal carcinoma and 2 of renal pelvic carcinoma.All these 15 cases were staged as T 1N 0M 0.The average tumor volume of the renal resection group was 3 cm?3 cm?2 cm.8 of hydronephrosis,2 of renal tuberculosis,4 of renal atrophied.Adrenal tumor resection group included 8 cases;the average tumor volume was 4 cm?5 cm?6 cm. Results Simple hand-assisted laparoscopic resection of the tumors was performed successfully in 36 cases without any complication such as injury of intestines and other important abdominal viscera except 1 case who underwent open surgery.The mean operative time of nephrectomy was 145 min,and that of adrenal giant tumor resection was 125 min.The mean blood loss was 110 ml.The patients recovered well and were discharged 7 to 8 days after operation.Follow-up lasted 3 months to 5 years after operation.Of the 37 cases,35 survived healthily;2 with renal carcinoma died (1 died of cerebrovascular accident 2 years after operation and the other died of brain and pulmonary metastasis 3 years after operation). Conclusions Simple hand-assisted laparoscopic resection of renal and adrenal giant tumor has the advantages of easier performance,shortened operative time and faster recovery from operation.Thus,this technique is worthy of popularization.

Objective To evaluate early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients. Methods We selected 165 renal transplant recipients who underwent transplantation from January 2007 to January 2009 and adhered to follow-up as research subjects. The samples of blood and urine were collected before transplantation, every 1 week from 2 to 8 weeks and every 2 weeks from 9 to 24 weeks after transplantation. The viral load of blood and urine was detected by fluorescence quantitative polymerase chain reaction (FQ-PCR). Once HCMV DNA load was more than 103 copies/ml, preemptive therapy was done immediately by ganciclovir. Results All the samples of blood and urine were negative before operation. HCMV DNA load could be detected in the concentrated urine at the second week and the peak of HCMV DNA loadoccurred from the sixth to eighth week after operation. At the same detection time, the number ofpositive recipients in the concentrated urine was more than in blood. In 30 cases HCMV DNA load was detected in the blood and the positive rate was 18.18%. In 64 cases HCMV DNA load was detected in the concentrated urine and the positive rate was 38.79%. The positive rate of the concentrated urine was significantly higher than in blood (P＜0.05). In 30 cases positive for HCMV DNA in the blood and urine, ganciclovir was given and the viral load was decreased gradually. But 8 recipients developed into CMV pneumonia and were cured through the comprehensive treatment. The clearance time of HCMV DNA in the concentrated urine was 10.2 ± 3.4 days. Thirty-four cases that were only positive for HCMV DNA in the urine were also treated by ganciclovir and no case developed into CMV pneumonia. The clearance time of HCMV DNA was 5.5 ± 2.1 days, and the clearance time was shortened as compared with that in those positive for HCMV DNA in the blood and urine (P＜0.05). Conclusion FQ-PCR can detect HCMV DNA in the concentrated urine in advance and increase the positive rate. Once the sample of the concentrated urine is positive, preemptive therapy has a good effect.

Objective To summarize the experience of diagnosis and surgical treatment of long distance ureteral stenosis after kidney transplantation. Methods Eleven cases of ureteral stenosis following renal transplantation were analyzed. Ureteral stenosis happened between 2-6 months after transplantation. The clinical manifestations were as follows: serum creatinine and weight elevated,urine decreased, graft area swelling. All cases were diagnosed using ultrasound, MRU or CTU. The ureteral obstruction length was 3-7 cm. In 5 patients a Boari flap technique was used, and the native ureter for pyelo-ureterostomy was used in 2 patients. Four patients were subjected to surgical operation using the native ureter for uretero-ureterostomy. Results All of the surgical treatments were successful and no operation-related complications occurred. The operation time was 2. 5 to 4 h.After reconstruction of ureter-bladder anastomosis, the urine was increased, the serum creatinine decreased to 75-156μmol/L, and uronephrosis disappeared or alleviated. The follow-up lasting 8 to 62 months showed no recurrence in all the cases. Conclusion For such cases, ultrasound should be routinely used for the possibility of stenosis. CTU or MRU is important to know the obstruction length and position. For the patients with long distance ureteral stenosis after kidney transplantation,surgical correction is the first choice.

Objective To discuss the clinical value of dynamic monitoring the copies of human cytomegalovirus(HCMV)-DNA in prophylaxis of HCMV pneumonia after renal transplantation.Methods There were 242 cadaveric renal transplantation recipients including 144 males and 98 females,with the average age of 41(from 17 to 71).They were divided into 2 groups(experimental group 127 cases,control group 115 cases).Recipients in experimental group were routinely monitored by blood preparation and urine aliquot FQ-PCR.The therapy was initiated when HCMC-DNA>1×103 copies/ml by blood preparation and/or urine aliquot FQ-PCR with intravenous ganciclovir for 4 weeks.The dosage was calculated according to creatinine clearance rate.FQ-PCR monitoring and Preemptive therapy was not performed in the control group.The pneumonia rate, death rate and survival between the two groups were compared. Results In experimental group, the HCMV pneumonia incidence rate was 6.3 % (8/127), onset time was 46-167 d, median time was 84 d, hospitalization time was 30-57 d,median time was 36 d, death rate was 12.5 % (1/8), breathing machine using rate was 12.5 % (1/8),concurrent other pathogen infection rate was 25 % (2/8), and + year renal graft survival rate was 98.4% (125/127).One was dead with graft function and the other dysfunction was because of acute rejection.In control group, the HCMV pneumonia incidence rate was 14.8%(17/115), onset time was 34-138 d,median time was 51 d, hospitalization time was 21-67 d,median time was 40 d,breathing machine using rate was 29.4% (5/17),concurrent other pathogen infection rate was 41.2%(7/17), death rate was 23.5% (4/17), and 1 year renal graft survival rate was 93.0% (107/115).Three was dead with graft function and the other one was dead of DGF.The other 4 cases of renal dysfunction were because of acute rejection.Significant difference existed between the 2 groups (P<0.05) except for hospitalization time (P> 0.05). Conclusion The preemptive therapy of CMV pneumonia after renal transplantation by dynamic monitoring the copies of HCMV-DNA in recipients could have a good effect, and the 1 year renal graft survival rate could be higher.

Objective To observe the clinical efficacy and safety of second transurethral resection combined with instillation therapy and transfusion therapy of dendritic cells pulsed with tumor cells on non muscle-invasive bladder cancer.MethodsEighty patients with stage T1 non muscle-invasive bladder cancer were included in this protocol in which all patients prospectively received second transurethral resection within 4 to 6 weeks following initial resection.All 80 cases were divided into a DC group and a control group.In the DC group,dendritic cells pulsed with tumor cells were transfused between 6 -8 weeks.Bladder instillation therapy and follow-up was applied on the control group.The recurrence rate,the clinical efficacy and adverse reactions were observed and compared between the two groups.ResultsIn the initial resection,21.3％,67.5％ and 11.2％ had G1,G2 and G3 transitional cell carcinoma,respectively.Twenty-seven (33.7％) had residual tumors at the second TUR,8 patients had Ta(29.6％ ) and 19 had T1 (70.4％).After the initial TUR-Bt,residual tumors were detected in 11.1％,70.4％ and 18.5％ in G1,G2 and G3,respectively.In the 8 Ta cases,2 cases moved to a higher grade,while the grade was unchanged in 6 cases.In the 19 cases with stage T1,12 had a higher grade,5 had a lower grade and 2 remained the same.In the DC group,5 cases suffered chills and fever when dendritic cells were transfused.The fever was releaved when dexamethasone was administered.The white blood cells count,creatinine and alanine aminotransferase had no statistically significance change at pre-therapy,one year after therapy and two years after therapy (P ＞0.05).The index of CD4 、CD8 、CD4/CD8 had statistically significance change at pre-therapy,one year after therapy and two years after therapy ( P ＜ 0.05 ),while the difference between one year after therapy and two years after therapy was not statistically significance ( P ＞ 0.05 ).The first and second year recurrence rate was 2％ and 6％ in the DC group,while in the control group it was 20％ and 30％.The difference was statistically significant ( P ＜ 0.05 ).Conclusion Second transurethral resection combined with instillation therapy and transfusion therapy of dendritic cells pulsed with tumor cells could be an effective therapeutic approach to lower the recurrence rate on non muscle-invasive bladder cancer.

Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex.Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed.There were 112 males and 74 females aged 35 to 83 years,average (59 ± 11)years.76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up.All patients underwent ultrasound,CT (plain scan/enhancement) and cystoscopy before operation.The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage,81 cases of T1 stage.There were 103 single cases and 39 multiple cases of non-muscular invasive bladder.According to the different surgical techniques,the patients were divided into two groups:the pre-excitation group and lateral incision group.There were 142 cases in pre-excitation group.In the pre-excitation group,the tumors were removed routinely by the resection ring.When the resection ring was far away from the tumors,the pedal switch was pressed to excite the resection ring.The resection ring was moved to the location of the tumors,and the tumors were cut to the muscular layer.The operation was completed after 2 cm electric cauterization around the wound and hemostasis.In the lateral incision group,the tumors were removed routinely by the electric resection ring.The operation time,incidence of obturator nerve reflex,incidence of bladder perforation,amount of bleeding,retention time of catheter,pathological grading,risk grading,hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups.Results The operation was successfully completed in both groups,and there was no transition to open operation.In the pre-excitation group,the operation time was 10 minutes to 56 minutes,with an average of (28 ± 12) minutes,and the intraoperative blood loss ranged from 5 ml to 70 ml,with an average of (35 ± 15) ml.In the lateral incision group,the operation time was 15 minutes to 65 minutes,with an average of (28 ± 11) minutes,and the blood loss was 10 ml to 80 ml,with an average of (40 ± 15) ml.There was no significant difference in operation time and blood loss between the two groups (P ＞ 0.05).There were only 3 cases of obturator nerve reflex in preexcitation group,the incidence was 2.1％.There were 13 cases of obturator nerve reflex in lateral resection group,the incidence was 29.5％.There was significant difference of nerve reflex incidence between the two groups (P ＜ 0.05).Conclusions In transurethral resection of bladder tumors,the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer.

Objective To investigate the influence of infection factors on kidney transplantation after organ donation and possible countermeasures.Methods Thirty-seven cases of kidney transplantation in Organ Transplantation Center of Qianfoshan Hospital Affiliated to Shandong University from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to perioperative infection prevention programs:42 patients with postoperative routine use of cephalosporins or penicillin for 2 weeks,and 95 patients with postoperative application of carbapenems + micafungin.Postoperative infection rate,occurrence time,pathogen infection;donor age,perioperative pathogens of donor and receptor (organ preservation solution,drainage fluid,urine,sputum samples),acute rejection,delayed graft function (DGF),diabetes mellitus,and the use of immunosuppressive agents were recorded.Results The infection rate in carbapenem + micafungin group was 12.6％,and the infection rate in cephalosporin or penicillin group was 19.4％ (P＜0.05).Pathogen positive detection rate of the drainage fluid,urine and sputum was lower in carbapenems + micafungin group than that in cephalosporins or penicillin (P＜0.05).Within 2 weeks after operation,the detection rate of bacteria and fungi in the carbapenems +micafungin infection prevention group was lower than that in the control group (P＜0.05).There was no significant difference in the detection of viruses (P＞0.05).There were no significant differences in the detection of pathogens among the two weeks to six months after surgery (P＞ 0.05).Donor infection,acute rejection,DGF,and diabetes mellitus were the risk factors for postoperative infection (P＜0.05).Conclusion The application of carbapenems and micafungin can reduce the incidence of infection for the early stage of DCD kidney transplantation.Donor infection,acute rejection,DGF and diabetes mellitus are all risk factors for the postoperative infection.

Nocardiosis is a collective term for tissue and organ damage caused by Nocardia infection. Solid organ transplant recipients (SOTR) are at an increased risk of various pathogen infections, including Nocardia infection, due to immunosuppressive therapy which weakens their immune function. The diagnosis of nocardiosis has been challenging in the past. With the advent of molecular biology and other diagnostic methods, the diagnostic rate has significantly improved. Nocardia not only prone to cause necrotic pulmonary lesions but also invade other organs and tissues, such as intracranial infections and skin soft tissue infections, and can develop into systemic disseminated infections. For SOTR, nocardiosis is a potentially fatal disease with a fatality as high as 30%. Therefore, this article reviews the clinical characteristics of common nocardiosis in SOTR, new diagnostic technologies, and different anti-infective treatment strategies, aiming to provide a reference for the prevention and treatment of nocardiosis in clinical SOTR.

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.